不同剂量右美托咪定对全麻食道癌患者术后苏醒期的影响

Clinical efficiency of dexmedetomidine with different doses during revival period of postoperative esophagus cancer in patients with general anesthesia

目的观察不同剂量右美托咪定(Dexmedetomidine,Dex)用于食道癌患者全麻手术后苏醒期的影响。方法选择开胸食道癌根治术患者120例,ASAⅠ～Ⅱ级,随机双盲分为4组(n=30):D1组(Dex负荷剂量:0.6μg/kg);D2组(Dex负荷剂量:0.6μg/kg,维持剂量为0.2μg/(kg·h);D3组(Dex负荷剂量:0.8μg/kg,维持剂量为0.2μg/(kg·h);C组(对照组泵注同等剂量的0.9%NS);插管成功后进行间歇正压通气,手术切皮前10min开始泵注各组负荷剂量,15min泵注完毕。记录四组患者入PACU时(T0)、拔管前(T1)、拔管后1min(T2)、拔管后5min(T3)和拔管后10min(T4)的HR、MAP和拔管时间;观察记录患者术中不良反应、在PACU时的Ramsay镇静及呛咳评分。结果在T1～T4时点,C组的MAP、HR和明显高于D1、D2和D3组(P<0.05);Ramsay评分C组明显低于D1、D2和D3组(P<0.05),而在呛咳评分和躁动,C组明显高于D1、D2和D3组(P<0.05);C组和D1组在手术中低血压发生率和拔管时间上明显低于D2和D3组(P<0.05);D3组高血压发生率明显高于C组、D1组和D2组(P<0.05)。结论术前单次泵注Dex负荷剂量0.6μg/kg用于食道癌根治术患者,不仅提供有效的镇静、镇痛辅助,术中血流动力学平稳,不影响拔管时间且不良反应少。

Objective To observe the effects of dexmedetomidine （ Dex） with different doses during revival period of postoperative esophagus cancer in patients with general anesthesia. Methods 120 patients, ASA grade Ⅰ～Ⅱ,undergoing radical resection of esophageal carcinoma under general anesthesia were randomly allocated to four groups with 30 cases each. Group D 1 ,group D2 ,group D3 and group C were respectively administered with Dex 0. 6,0. 6,0. 8 μg / kg or 0. 9% normal saline by micro-pump finished in 15 minutes before operation. Group D2 and group D3 kept injection the Dex at 0. 2 μg / （ kg·h） until operation finished. MAP, HR and Ramsay scores were monitored and recorded at the time points of just to the PACU （ T0 ） ,before extubation （ T1 ） ,after extubation 1 min （ T2 ） ,after extubation 5 min （ T3 ） and after extubation 10 min （ T4 ） . The extubation time and the incidences of adverse effects were observed and recorded. Results The values of MAP,HR at T1 ～ T4 ,bucking scores and restlessness in group C were significantly higher than those in each group D（ P 0. 05） . Ramsay scores in group C were lower than that in group D（ P 0. 05） . The extubation time and the incidences of hypotension in group C and group D1 were found significantly higher than those in group D2 and group D3 （ P 0. 05） . The incidences of hypertension in group D3 were significantly higher than that in others（ P 0. 05） . Conclusion The single 0. 6 μg / kg dose of Dex in 15 min used in patients with esophageal cancer by micro-pump before operation. It can provide obvious sedation,may keep stable perioperative hemodynamics and minimize the adverse effects without prolong the extubation time and recovery time.